Provider Demographics
NPI:1629053954
Name:MINKIN, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MINKIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30840 NORHTWESTERN HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2555
Mailing Address - Country:US
Mailing Address - Phone:248-932-1250
Mailing Address - Fax:248-932-8977
Practice Address - Street 1:30840 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2555
Practice Address - Country:US
Practice Address - Phone:248-932-1250
Practice Address - Fax:248-932-8977
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-02-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301039817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629053954Medicaid
MI700F319250OtherBLUE SHIELD
MI06301492OtherBCBS INDIVIDUAL
MI110241690OtherRR MEDICARE
MI15499OtherGREAT LAKES HEALTH PLAN
MI128906OtherCARE-PREFERRED CHOICES
MI128906OtherCARE-PREFERRED CHOICES
MI700F319250OtherBLUE SHIELD